EVALUATION OF APPROPRIATE USE OF ANTIFUNGAL THERAPY IN A TERTIARY CARE HOSPITAL
Abstract
ABSTRACT
Objective: Appropriate use of antifungal therapy has becoming a worrying issue since misuse of antifungal may contribute to the emergence and
global increase in antifungal resistance. Use of a more standardized approach in identifying appropriate use is required in an attempt to reduce the
risk of resistance. The study assesses the appropriate use of antifungal therapy in a local tertiary care hospital.
Methods: It was conducted as a retrospective study based on patients prescribed antifungals for the past 1 year.
Results: The A total of 135 patients were included in the study. The majority of the patients were Malay (n=77, 57%), followed by Chinese (n=39,
28.9%), Indians (n=11, 8.1%) and others (n=8, 5.9%). The mean age of patients was 57.5±16.58 years. The mean duration of admission was
29.39±21.85. Overall assessment of antifungal use demonstrated that antifungal therapy was appropriate in 85 (44.7%) cases, debatable in 34 (17.9%)
and inappropriate in 71 (37.3%) cases (p=0.000015). There was a significantly high number of inappropriate azole use (p=0.0001) in the study
population. The most common type of azole used was fluconazole. Further analyses identified that demographic factors that affected the duration of
admission of those that survived were age, number of medication and number of antifungals. Duration of admission increased with increasing age
(r=0.219, p=0.044), increase in medication (r=0.333, p=0.0019) and increase in number of antifungal treatment given (r=0.239, p=0.027).
Conclusion: This work demonstrated the need for a closer or more stringent efforts in reducing inappropriate antifungal use.
Keywords: Appropriateness, Antifungal therapy, Fungal infections.
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REFERENCES
Ashley DE, Lewis R, Lewis JS, Martin C, Andes D. Pharmacology of systemic antifungal agents. Clin Infect Dis 2006;43:28-39.
Parkins MD, Sabuda DM, Elsayed S, Laupland KB. Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections. J Antimicrob Chemother 2007;60(3):613-8.
Asian J Pharm Clin Res, Vol 8, Issue 4, 2015, 195-199
Islahudin and Mohd
Herbrecht R, Berceanu A. Beta-D-glucan detection test: A step toward preemptive therapy for fungal infections in leukemic patients? Clin Infect Dis 2008;46(6):886-9.
Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the infectious diseases society of America. Clin Infect Dis 2009;48:503-35.
Sutepvarnon A, Apisarnthanarak A, Camins B, Mondy K, Fraser VJ. Inappropriate use of antifungal medications in a tertiary care center in Thailand: A prospective study. Infect Control Hosp Epidemiol 2008;29(4):370-3.
RamÃrez E, GarÃa-RodrÃguez J, Borobia AM, Ortega JM, Lei S, Barrios-Fernandez A, et al. Use of antifungal agents in paediatric and adult high-risk areas. Eur J Microbiol Infect Dis 2011;31(3):337-47.
Garey KW, Pai MP, Suda KJ, Turpin RS, Rege MD, Mingo DE, et al. Inadequacy of fluconazole dosing in patients with candidemia based on Infectious Diseases Society of America (IDSA) guidelines. Pharmacoepidemiol Drug Saf 2007;16(8):919-27.
Loeffler J, Stevens DA. Antifungal drug resistance. Clin Infect Dis 2003;36 Suppl 1:S31-41.
Nivoix Y, Launoy A, Lutun P, Moulin JC, Phai Pang KA, Fornecker LM, et al. Adherence to recommendations for the use of antifungal agents in a tertiary care hospital. J Antimicrob Chemother 2012;67(10):2506-13.
Cusini A, Rampini SK, Bansal V, Ledergerber B, Kuster SP, Ruef C, et al. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: A prevalence survey. PLoS One 2010;5(11):e14011.
Zilberberg MD, Kollef MH, Arnold H, Labelle A, Micek ST, Kothari S, et al. Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: A retrospective cohort study. BMC Infect Dis 2010;10:150.
Department of Statistics Malaysia, Official Portal. Department of Statistics, Malaysia 2014. Available from: http://www.statistics.gov.my/portal/index.php?lang=en. [Last accessed on 2015 Mar 03]
Gutiérrez F, Wall PG, Cohen J. An audit of the use of antifungal agents. J Antimicrob Chemother 1996;37(1):175-85.
Oberoi JK. Invasive candidiasis. J Int Med Sci Acad 2010;23(1):25-8.
López-Medrano F, San Juan R, Lizasoain M, Catalán M, Ferrari JM, Chaves F, et al. A non-compulsory stewardship programme for the management of antifungals in a university-affiliated hospital. Clin Microbiol Infect 2013;19:56-61.
Carrillo-Muñoz AJ, Quindós G, Tur C, Ruesga MT, Miranda Y, del Valle O, et al. In-vitro antifungal activity of liposomal nystatin in comparison with nystatin, amphotericin B cholesteryl sulphate, liposomal amphotericin B, amphotericin B lipid complex, amphotericin B desoxycholate, fluconazole and itraconazole. J Antimicrob Chemother 1999;44(3):397-401.
Glasmacher A, Prentice AG. Evidence-based review of antifungal prophylaxis in neutropenic patients with haematological malignancies. J Antimicrob Chemother 2005;S1:i23-32.
Yeo SF, Wong B. Current status of nonculture methods for diagnosis of invasive fungal infections. Clin Microbiol Rev 2002;15(3):465‑84.
Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: A potential risk factor for hospital mortality. Antimicrob Agents Chemother 2005;49(9):3640-5.
Schuster MG, Edwards JE Jr, Sobel JD, Darouiche RO, Karchmer AW, Hadley S, et al. Empirical fluconazole versus placebo for intensive care unit patients: A randomized trial. Ann Intern Med 2008;149(2):83-90.
Lee W, Liew Y, Chlebicki MP, Ong S, Lee P, Kwa A. An observational study on early empiric versus culture-directed antifungal therapy in critically Ill with intra-abdominal sepsis. Crit Care Res Pract 2014;2014:479413.
Elting LS, Cooksley C, Chambers M, Cantor SB, Manzullo E, Rubenstein EB. The burdens of cancer therapy. Clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 2003;98(7):1531-9.
Bensinger W, Schubert M, Ang KK, Brizel D, Brown E, Eilers JG, et al. NCCN task force report. Prevention and management of mucositis in cancer care. J Natl Compr Canc Netw 2008;6 Suppl 1:S1‑21.
Barberino MG, Silva N, Rebouças C, Barreiro K, Alcântara AP, Netto EM, et al. Evaluation of blood stream infections by Candida in three tertiary hospitals in Salvador, Brazil: A case-control study. Braz J Infect Dis 2006;10(1):36-40.
Smith M, Higgs J, Ellis E. Factors influencing clinical decision making. Clinical Reasoning in Health Professions. 3rd ed. Amsterdam: Butterworth Heinemann; 2008.
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